For most of the past 15 years Texas A&M University's governance has worked well. Over the first 10 years of this period, President Ray Bowen's initiative of Vision 2020 - Creating a Culture of Excellence set a goal of establishing Texas A&M as one of the 10 best public universities in the country by the year 2020. At the turn of the century, our board of regents formally endorsed 2020 with the provision that "the general principles outlined … become a guide for the future direction of Texas A&M University and a permanent expression for excellence."

Primarily on the basis of 2020, the university was invited into the company of the nation's most prestigious research institutions - the Association of American Universities - where it joined only two other Texas institutions. Following President Bowen's retirement, successor President Robert Gates embraced the template of Vision 2020 and used it to add quality faculty, enhance collaborative governance and to enhance the standing of, as he called it, "a unique American institution."

Then, three or four years ago, the governance train began to go off the tracks. Today, governance at this important state institution has failed its community and the state's citizens.

Shortly after President Gates departed for the Pentagon, the politicization of the university began to overwhelm the basic integrity of governance at A&M. By politicization, I mean that the appointment of regents and the chancellor, and their influence on the university, began to be driven more by political goals and political loyalty than by demonstrable qualities of stewardship and the best fiduciary interests of the university.

It is impossible to overlook Gov. Rick Perry's role as a catalyst in all of this. By virtue of his time in office, he has appointed every regent. Further, protestations to the contrary, he has evidenced a keen interest in the workings of higher education. The minutes of the Governor's Higher Education Summit on May 21, 2008, - with 45 regents from six universities and Jeff Sandefer of "Seven Solutions" fame in attendance - show without any doubt the breathtakingly wide scope and penetrating extent of the governor's interests in higher education.

In brief, those minutes reflect a political effort to force a radical restructuring of Texas higher education toward a simplistic focus on teaching efficiency. Notably absent from this meeting was a respect for the current institutional structure of higher education (i.e., either for the Legislature or the Higher Education Coordinating Board) or an appreciation for the benefits of a more straightforward engagement of the institutions involved.

At A&M, in the 2007-2009 era, the results of the politicization were increasingly clear. Both the chancellor and the chair of the regents were former members of the governor's staff, and it seemed to a great many people - including me - that neither man was selected for his leadership qualifications or experience with educational institutions. Worse, the empowerment of the chancellor to direct operational authority over the flagship - a violation of longstanding practice and contrary to best national practices - led to a debilitating rupture of the flagship's academic and administrative autonomy.

Other manifestations of failing governance were poorly managed presidential searches, sizable "settlements" with a pushed out president and chancellor, and direct intervention with senior university appointments. While our university's student center was being remodeled, the arrogance of the regents manifested itself when they insisted on maintaining - at substantial incremental cost to the taxpayers - uninhibited access to their quarters within the building.

If all of this were not enough, we now know that our politically pliant board of regents team was monitoring the implementation of "The Seven Breakthrough Solutions" quietly and without any public disclosure or discussion. During all of this, one A&M regent sat - and continues to sit - in the very conflicted position of also being a board member of The Texas Public Policy Foundation, the official initiator of the "Solutions."

A few months ago, 22 distinguished alumni of the university spoke out publicly. As a result, we were invited to meet, after a month, with two regents. As we tried to engage these two regents in substantive discussions about the denigration of governance processes at the university, we were mostly told that we had bad information and that we couldn't understand or didn't know what was going on.

And so, as we approach the hearings of the Joint Oversight Committee on Higher Education Governance, Excellence and Transparency, I must speak out as one who believes we have witnessed a fine university's descent into failed governance. It is clear to me that our current regents, as a group, are not up to the high standards their jobs demand. They have earned a vote of "No Confidence" from me.

A first-rate university is a treasure and a great gift to the people; it should be held accountable by legitimate, thoughtful, interactive oversight. Reinterpretation of its mission and restructuring of its management for political purposes should never be allowed.

medical care; 20 percent is due to public health standards, like immunizations and using seat belts; 30 percent is due to your genes; and a whopping 40 percent is lifestyle. There is a lot to lifestyle, including obesity, smoking, murders, drug abuse, becoming pregnant as a teenager, race, ethnicity, living in a rural area or inner city, poverty and lack of health insurance. We have more than 50 million people who have no health insurance in the U.S., and a lack of health insurance means patients die earlier: estimates put the number as high as 20,000 per year in the U.S. People without health insurance have about twice the chance of dying in middle age as those who have insurance.

So why does it matter if we mix up medical care and health care? It matters when we try to fix health care statistics by throwing more money at medical care. We already spend about twice as much per person on medical care as any other country. But because medical care is only 10 percent of what contributes to life expectancy, pouring more money into medical care won't make a lot of difference. So what we really need to do is attack our terrible health care indices with health care solutions: provide access to medical care through health insurance (Medicaid or private), improve our eating and smoking habits and stop killing people with violence and cars.

Great medical centers and terrible health care? True.

Garson, the former chief of pediatric cardiology at Texas Children's Hospital and senior vice president and dean of academic operations at Baylor College of Medicine, is the director of the Center for Health Policy, a university professor and professor of public health sciences at the University of Virginia. Engelhard, a graduate of the University of St. Thomas, is an assistant professor and director of the Health Policy Program, Department of Public Health Sciences, University of Virginia. Garson and Engelhard are co-authors of "Health Care Half Truths: Too Many Myths, Not Enough Reality."